Physicians and administrators can work together

This article describes the working relationship between the administration and medical staff of the Mid-Maine Medical Center which is comprised of two separate modern hospitals. The authors advocate the philosophy that "a hospital which harnesses the medical staff's considerable talent and expertise through sound organizational input will be a stronger institution." They explain that patient care is becoming increasingly complex and that management decisions impact heavily on the care provided. In 1973, the Medical Center changed from its traditional organizational form of having a full-time medical director and an administrator report to the board of directors, to a modified corporate model designed to increase physician involvement. In the new organization, the vice president of finance and a part-time chief of staff (acting as vice president for medical affairs) report to the president (former medical director) who, in turn, is responsible to the board of trustees. The authors attribute the success of the reorganization to the CEO's willingness to delegate and share authority, not to the CEO's physician background. Planning at the institution involves a committee of six physicians, four administrators, and one full-time planner. A budgeting committee of three physicians and three administrators is responsible for the review of the budget as well as for making recommendations for the executive board for the expected volume of services. It is concluded that there is no perfect way to run a hospital, but the involvement of doctors in hospital decisions is necessary.     

PHYSICIANS AND RESOURCE MANAGEMENT: THE ROLE OF ACCOUNTING AND NON-ACCOUNTING CONTROLS

Prior research has identified the difficulties associated with encouraging physicians to 'take resource management to their hearts' and has questioned the efficacy of implementing management accounting systems (MASS) in the health care setting. Although physicians are now being integrated into management structures, they typically do not identifjr with managerial values and goals. This creates a potential impediment to the effective implementation of accounting-based controls. No prior research has, however, assessed if this impediment is equally significant in the effective implementation of other non-accounting forms of control. This paper builds on prior research and assesses the extent to which a physician manager's managerial orientation significantly influences the effectiveness of both accounting and non-accounting forms of control. The paper contributes to the literature by simultaneously assessing the effect of managerial orientation on the use and relative importance of three forms of control. The results confirm the importance of an identification with managerial values and norms for the effective implementation of management accounting systems. This orientation, did not, however, appear to be important for the effective implementation of non-accounting forms of control. These findings have direct implications for the design of effective management control systems in hospitals and other organizations dominated by professionals.     

Fabricating budgets: A study of the production of management budgeting in the national health service

This paper examines the processes by which a form of responsibility accounting system emerges in an organizational context. The paper utilizes recent approaches to the understanding of how science and technology is created (Latour, Science in Action, Harvard University Press, 1987) to investigate the processes by which a management budgeting initiative in the U.K. hospital system takes hold (or not) in specific hospitals. The approach is critical of the notion that accounting systems are well-defined technologies which are designed and then implemented (or face resistance). Instead, the study shows that management budgeting is fabricated, put together in a changing and fragile manner. Emerging accounting systems are not fixed technologies with well-defined purposes which reflect patterns of responsibility but changing constructions. Management budgeting systems are initiated with loose characteristics, purposes and uses. In the process of their design and implementation, new possibilities for decision making and definitions of responsibility emerge. Through this study of accounting in action, the paper explores the processes by which accounting and budgeting systems bring economic logic into hospital management. It is also relevant to debates about the role of budgeting and accounting in health care organizations in many countries.     

Budgeting and the propensity to create budgetary slack

This paper reports the results of a field study designed to investigate how managers' propensities to create budgetary slack are affected by the budgeting system and the technical context. The results show that propensities to create slack are lower where managers participate actively in budgeting, particularly when technologies are relatively predictable. But such propensities are higher if a tight budget requires frequent tactical responses to avoid overruns.     

The effect of participative budgeting on job satisfaction and performance: Role ambiguity as an intervening variable

The results of studies into the effects of participative budgeting have been equivocal. This study seeks to explain the process by which participation in budget setting affects managers' performance and job satisfaction. A model is developed to show how role ambiguity acts as an intervening variable in the link between participation and outcome criteria. Empirical results indicate that budgetary participation acts indirectly, via role ambiguity, to influence job satisfaction and performance.     

The budgetary process of power and politics

The traditional literature has long espoused the claim that budgeting facilitates and enables technically rational decision-making within organizations, and that good budgeting reflects organizational reality. In contrast, an emergent view reasons that budgeting systems may as much be constitutive of reality, that they are an integral part of the politics and power of organizational life and that they are used to legitimize action.The purpose of the paper is to consider the usefulness of the emergent theory in understanding budget-related behavior in six hospitals. More specifically, the complicity of budgeting in performing or not performing six management roles is examined. Based on intensive interviews with nursing managers, it is concluded that the emergent theory meaningfully describes much budget-related activity in the hospitals, but that double-reflexivity on the part of the researcher is necessary in order to understand both the merits and limitations in the emergent theory. Implications of the analysis and empirical inquiry are considered.     

Torts, expertise, and authority: liability of physicians and managed care organizations

We examine optimal individual and entity-level liability for negligence when expected accident costs depend on both the agent's level of expertise and the principal's level of authority. We consider these issues in the context of physician and managed care organization (MCO) liability for medical malpractice. Under current law, physicians generally are considered independent contractors and hence MCOs are not liable for negligent acts by physicians. We find that the practice of reviewing the medical decisions of physicians affects their incentives to take care, which in turn implies that it is efficient for MCOs to be held liable for the torts committed by their physicians.     

Linkages between organizational goals,strategies, and the budget process

This case is ideally suited to integrate organizational goals and strategies with budgeting, feedback, and variance analysis. It demonstrates the interplay between the budget process and organizational goals and strategies. The case is also useful in integrating accounting concepts with concepts which students have studied in management or organizational behavior courses. It suggests that the way that managers respond to variances is affected by the environment in which the firm operates and the product(s) manufactured by the firm. This case is based upon an actual situation in which a firm experienced rapid growth through acquisition. Integration of the budget process with organizational goals and strategies enhances the students' interest and their understanding of the role of budgets in the planning and control process. The case demonstrates that budgets are part of a “big picture,” and can be traced and related to managerial goals and strategies. Further, the case allows students to develop an understanding and appreciation of variance analysis. The case has been used successfully with undergraduate cost accounting students and with participants in a 2-week executive-education program. The students find the case interesting and are eager to participate in the discussion.     

高管宏观认知具有管理者“烙印”吗？——基于管理者风格效应的实证检验

本文利用“管理层讨论与分析”(MD&A)中的文本信息构造高管宏观认知指标(MMC),研究高管宏观认知是否具有管理者风格效应及其作用机理。研究发现,高管宏观认知具有明显的管理者个体“烙印”,会受到管理者个人风格的显著影响,表现为管理者风格效应。进一步研究发现,管理者个人背景特征对高管宏观认知的管理者风格效应具有显著影响,管理者风格效应主要受管理者后天因素的影响。管理者能力与高管宏观认知的管理者风格效应显著正相关。     

Telling the data story the right way

Effective data-driven analyses of service-line performance require: Buy-in and agreement at the outset from all parties (hospital and physicians) on the validity of the data used to evaluate service-line performance, Actionable data and metrics relevant to physicians, with financial goals tangibly linked to clinical improvement, Transparent sharing of data with physicians to build their trust and support the case for change, A physician champion who can help validate findings and guide how data are presented, Willingness of physicians to acknowledge that the opportunity for improved margin depends largely on the variable costs that they control as individuals.     

Outcome effect, controllability and performance evaluation of managers: some field evidence from multi-outlet businesses

This field study provides evidence of the outcome effect in performance evaluations of managers in an organization. Specifically, in a retail chain, subjective evaluations of store managers by their supervisors were negatively impacted by unfavorable outcome knowledge. As expected, outcome determinants over which the managers have control influence their performance evaluations and environmental determinants of outcome over which they have no control do not influence their evaluations. However, unexpectedly, central management determinants of outcome over which the managers have no control also influence their evaluations. After these outcome determinants are considered, we find evidence of an outcome effect since failure of the store to meet its target outcome results in a more negative performance evaluation of the managers. Also, the extent to which store managers' evaluations are prone to the outcome effect is not contingent on the measure of the outcome used.     

Institutional Pressures, Monopolistic Conditions and the Implementation of Early Cost Management Practices: The Case of the Royal Tobacco Factory of Seville (1820–1887)

In spite of our increasing understanding of the underpinnings of early cost management systems, little is still known about the reasons for the implementation of such systems in firms operating under monopolistic conditions. This article studies the enforcement by law of cost and budgeting systems in the Royal Tobacco Factory of Seville (Spain), a manufactory of the state-owned monopoly. By doing this, we seek both to enhance understanding of the state's motivation to enact institutional pressures aiming at the implementation of early cost management practices as well as to study different organizational responses to simultaneous pressures arising from a single institutional source. It is suggested that the state's motivation to legally enforce the implementation of early cost and budgeting systems may be attributed to (a) the seeking of legitimacy by the state regulatory body, (b) the active agency of senior employees of the state regulatory body to keep their jobs and compensation packages on the eve of the privatization of the industry, and (c) the interest of the regulatory agency to instil the basis of mimetic isomorphism within the monopoly. Different responses by the RTF to pressures for reporting cost and budgeting information were explained by (a) the expected diffusion of firm's non-conformity within the institutional area, (b) the expected impact of institutional rules and norms on organizational goals, and (c) the extent to which the institutional source is consistent in its demands.     

A Special Breed?– A Longitudinal and Cross‐Sectional Study of Norwegian Budgeting and Financial Civil Servants

Abstract: This paper focuses on civil servants in the central Norwegian civil service whose main tasks are budgeting, supervision and accounting. The main research questions are: (a) What is their typical demographic profile? (b) How has their demographic profile changed over time? (c) What are the effects of having budgeting, supervising and accounting as a main task on civil servants’ attitudes and behaviour? The main findings are that they have a specific profile. There are significant differences between ministries and central agencies as well as changes over time and also marked differences with other civil servants regarding their attitudes and behavior.     

NPM REFORMS AND THE PERCEPTION OF BUDGET BY HOSPITAL CLINICIANS: LESSONS FROM TWO CASE‐STUDIES

This paper investigates how clinicians perceive managerial budgeting and how this affects clinical practice. To this end, case‐studies were conducted involving two Italian public hospitals. The results show that clinicians' commitment to organizational objectives was strongly enhanced by the use of the budget as a means to evaluate and reward clinicians' performance. One of the main lessons learned from this study is that aligning existing institutions to organizational objectives is the only way forward for effective reform implementation. Consequently, the challenge for future reforms is to deal with the search of balance between efficiency goals and existing institutions.     

“Continuous” budgeting: Reconciling budget flexibility with budgetary control

This paper explores the role of budgeting in the context of the more flexible modes of management required in conditions of uncertainty. It contributes to the growing literature on the tensions between the need to meet specified financial targets, as expressed in budgets, and the need for more flexible and innovative forms of managing prompted by heightened market volatility and rapid rates of technological change. Drawing on case study evidence, the paper introduces the notion of “continuous budgeting” to highlight the ways in which one organization sought to reconcile these potentially conflicting objectives. By integrating different uses of budgeting with other management controls, the processes of “continuous budgeting” encouraged managers to use their discretion in operational matters when confronted by unexpected events. Consequently, it enabled managers to prioritise, as necessary, the revision of plans and reallocation of resources in order to meet wider strategic organizational objectives. As well as empowering managers, “continuous budgeting” also imposed strict accountabilities to ensure that managers remained committed to achieving their own and the organization’s financial targets. Thus far from being an obstacle, budgeting contributed effectively to both the flexibility and the financial discipline required for effective strategy implementation.     

企业控制权配置与经营者业绩评价

对经营者的业绩进行评价,应当考虑企业的控制权配置方式。企业控制权的配置方式不同,对经营者业绩进行评价的主体、目标、内容及方法都会存在很大的差异。本文在分析了企业所有权与控制权不同配置方式的基础上,进一步阐述了不同所有权与控制权配置方式对企业运转目标及对企业经营者业绩评价的影响。最后对我国国有企业、存在控股股东的企业及股权分散企业的所有权与控制权配置特点、企业目标及经营者业绩评价的相关问题进行了论述。     

预算功能彰显及其绩效研究——基于我国企业预算管理调查问卷的实证检验

本文在提炼与描述了预算的四项功能(业务规划、业绩评价、目标沟通、战略形成)的基础上,研究了各项预算功能彰显程度的环境决定因素、预算功能与预算特征的关系,以及各项预算功能是如何影响组织绩效的。研究发现,预算功能具有多重性,预算环境是各种预算功能彰显的重要驱动因素,各项预算功能都伴随着相应的预算特征,并对组织绩效产生不同影响。     

Medical foundations: one model for hospital-physician alignment

Some states that enforce a corporate practice of medicine prohibition have created medical foundation statutes allowing hospitals or health systems to own corporations providing physician services. Medical foundations may be useful in the coordination of care through employed or contracted physicians. Medical foundations that qualify as a tax-exempt entities have lower risks associated with tax-exempt rules as long as payments to physicians are reasonable and don't result in private inurement.     

On Being a Financial Manager in a Church Organisation: Understanding the Experience

Accountants and financial managers, as individuals and as occupational groups, are largely invisible in the growing body of financial management literature. In particular, limited privilege has been given to the experiences of financial managers in organisations dominated by social or value‐based goals, rather than financial motives. To begin to address this lacunae, this paper presents a micro study of financial managers 'in motion'( Hopwood, 1987 ) in the state division of a large Australian church. By explicating the financial managers' own perspectives of their experiences, the study provides a unique perspective of understanding of what it is to 'be' a financial manager in a non‐profit entity.